[Long-term analysis of causes, sites and results of treatment of urogenital fistulas at the Charité Gynecologic Clinic].

Analyses of aetiology, localisation, and curing of urogenital fistulae permit conclusions as to efficiency of public health services. Recorded are 810 fistulae in 45 years which were analysed by 15-year periods. The ratio of obstetric to gynaecological fistula causes has remained unchanged through the entire period under review (10:90). However, substantial shifting was observed within either main group. In obstetrics, vesicocervical and vesicovaginal fistulae following caesarean section, have been predominant and on rising trend for 30 years. In gynaecology, vesicovaginal fistulae in the wake of vaginal and abdominal hysterectomy have considerably increased in the last 15 years. The present of benign to malignant primary diseases is 70 to 20%, as compared to 40:50% in the past. Vesicovaginal fistulae have continued to account for 60% of the general incidence. Urethral fistulae have gone up from 6 to 13%, while ureteral and trilocal fistulae have dropped from 20 to 16 and 11 to 7%. Fistula incidence figures at present are 0.01% obstetric as well as 0.2-0.5% benign and 0.7-1.4% malignant gynaecological causes. Rates of healing improved from 90 to 96% in obstetrics and stayed constant in gynaecology (94% benign and 80% malignant). The worst prognosis has continued to be recordable from trilocal fistulae. Current principles of therapy are, finally, put to discussion, together with modifications to the therapeutic régime. The conclusion is drawn that operations on women for urogenital fistulae should be performed only in urogynaecological centres and that fistula prophylaxis should be further intensified, especially in the context of gynaecological standard operations.